Can Lithium Help With Hyperthyroidism and Graves’ Disease?

Published November 16 2015

Many people with hyperthyroid conditions take antithyroid medication to help manage their symptoms. But while antithyroid drugs such as Methimazole and PTU usually do a good job of lowering the thyroid hormone levels, these can be harsh on the liver, and it’s not uncommon for people to experience side effects. As a result, many people with hyperthyroidism and Graves’ Disease prefer a natural alternative to manage their symptoms. Bugleweed is an herb that can lower thyroid hormone levels, and high doses of L-carnitine can also have antithyroid activity. Lithium is another option for those with hyperthyroidism, as this also can lower the thyroid hormone levels.

Lithium has been used for decades as a mood stabilizer in people with bipolar disorder. However, it’s still not well understood how it helps with mood, although at a neuronal level it reduces dopamine and glutamate, while increasing GABA neurotransmission (1). It also seems to reduce oxidative stress that commonly occurs with depression, and increases protective proteins such as brain-derived neurotrophic factor (2)(3). Telomeres are DNA-protein complexes that protect the chromosomes from damage, and they are maintained primarily by the enzyme telomerase. It appears that lithium can normalize telomerase dysregulation (3), although more studies need to be conducted.

But how does lithium help with the symptoms of hyperthyroidism and Graves’ Disease? Lithium can affect the production of thyroid hormone in multiple ways. First of all, lithium inhibits iodine uptake, and iodine is important for the formation of thyroid hormone. It also inhibits iodotyrosine coupling, alters thyroglobulin structure, and inhibits thyroid hormone secretion (4). Lithium also decreases peripheral deiodination of thyroxine (T4) by decreasing the activity of type I 5′ de-iodinase enzyme (5). In other words, it affects the conversion of T4 to T3.

Are There Any Risks Associated With Lithium?

Although lithium might sound like a great natural alternative to lowering thyroid hormone levels in people with hyperthyroid conditions, there are risks associated with its use.

Lithium and Chronic Kidney Disease. First of all, there is evidence that lithium can have a negative impact on the health of your kidneys (6)(7). One study showed that the presence of lithium in the blood was associated with an increased risk of stage three chronic kidney disease (7). However, this does seem to be associated with the long term use of lithium. A recent study looked at the effects of 10 to 30 years of lithium treatment on kidney function, and showed that about one-third of the patients who had taken lithium for 10 years or greater had evidence of chronic renal failure, although only 5% were in the severe or very severe category (8). While one can argue that most people with hyperthyroidism would be taking lithium for a much shorter period of time, I’m still cautious about recommending lithium to manage the symptoms, and usually resort to herbs such as bugleweed.

Lithium and Hyperparathyroidism. Lithium can also lead to hypercalcemia (high calcium levels in the blood) associated with hyperparathyroidism (9)(10)(11). And while this can be reversible in some people, this isn’t always the case. Once again, this is usually associated with long term use of lithium, and so if someone is considering taking lithium for a few months then the risk of developing hyperparathyroidism is very low.

Lithium during pregnancy. One of the challenges with pregnant women with hyperthyroidism and Graves’ Disease is managing the symptoms during this time without drugs. Keep in mind that I never tell a woman with hyperthyroidism not to take antithyroid medication, but many women understandably prefer not to take any medication during pregnancy. Of course everything comes down to risks vs. benefits, and in my opinion the risk of untreated hyperthyroidism is usually greater than the risk of taking medications to lower the thyroid hormones. Unfortunately the herb bugleweed is contraindicated during pregnancy. Although some women with depression and bipolar disorder take lithium during pregnancy, it does seem to have teratogenic effects (12)(13)(14)(15), and thus I wouldn’t advise its use during pregnancy for managing the hyperthyroid symptoms.

Lithium Carbonate vs. Lithium Orotate

Most of the studies involving lithium causing hypothyroidism used lithium carbonate. However, a medical doctor would need to prescribe lithium carbonate, and most will be unwilling to do this for managing the hyperthyroid symptoms. Lithium orotate can be purchased over-the-counter, but it’s unclear exactly how much someone with hyperthyroidism can safely take without putting significant stress on the kidneys. An older study looked at kidney function and lithium concentrations of rats given lithium orotate or lithium carbonate, and found that lithium orotate had a negative effect on kidney function, and the authors therefore advised not to use lithium orotate for the treatment of patients (16). But more research probably is needed in this area. Another thing to keep in mind is that some sources claim that lithium orotate is more bioavailable, and thus a much smaller dosage might be needed to inhibit thyroid function. I did come across one lithium orotate toxicity case study involving an 18-year old woman (17), although she took 18 tablets of lithium orotate, which definitely is not recommended!

What’s The Final Verdict On Taking Lithium For Hyperthyroid Conditions?

A small study involving thirteen patients looked to evaluate the efficacy and safety of lithium in the treatment of thyrotoxicosis (18). The median dosage of lithium was 750 mg daily (250mg of lithium carbonate 3x/day). A satisfactory response was achieved in eight patients within one to two weeks of lithium therapy. Four other people saw a significant decrease in thyroid hormone levels in three to five weeks. Lithium toxicity was observed in one patient. The authors concluded that a relatively low dose of lithium offers a safe and effective means of controlling thyrotoxicosis in patients who cannot tolerate or do not respond to antithyroid medication.

Based on this study it would seem that lithium is a good option for those who prefer not to, or are unable to take antithyroid medication. However, keep in mind that the study I just mentioned involved only thirteen patients, and I don’t think that the potential side effects can be completely dismissed, even though they are usually experienced only with long term use of lithium. I prefer for my patients to try herbs such as bugleweed and lemon balm first, and/or taking higher doses of L-carnitine. If this doesn’t work and if the patient doesn’t want to take antithyroid medication, or is unable to take it, then perhaps taking lithium is an option to consider on a short term basis while trying to address the cause of the problem.

In summary, lithium can inhibit iodine uptake and thyroid hormone secretion, which can potentially benefit people with hyperthyroidism and Graves’ Disease. Although it might be fine to take lithium on a short term basis, studies show that taking lithium for a prolonged period of time can decrease kidney function, and can also lead to hyperparathyroidism. Lithium carbonate was used in most studies, but isn’t available over the counter. Lithium orotate is available without a prescription, and appears to be more bioavailable than lithium carbonate. I personally prefer bugleweed over lithium, although if bugleweed and other antithyroid herbs and supplements aren’t effective and if someone is unable to take antithyroid medication, then lithium might be a good option for some people with hyperthyroidism on a short term basis.